Erectile Dysfunction

Erectile Dysfunction may develop from a multitude of medical, psychological, and life-style related causes. Successful penile erections relay on a healthy body-mind interplay between neurobiological signals of sexual desire and arousal, healthy central nervous system responses, and healthy cardiovascular function allowing blood inflow into the penile erectile tissue (corpus cavernosum and corpus spongiosum), and blood outflow after a man’s sexual arousal relaxes. Any interruption to either good mental or physical health may cause erectile dysfunction (ED).

Increasing numbers of sex and porn addicts, including healthy young men, report difficulties with erectile dysfunction such as obtaining or maintaining erections when attempting sex with a partner. This type of ED is believed to be caused by repeatedly triggering abnormally high sexual arousal with chronic pornography over-consumption and it’s harmful impact on the brain’s complex dopamine pathways. A 2014 scientific study of pornographic behaviour, involving fMRI brain scanning, has cautioned consumers of being at increased risk of developing Pornography Induced Erectile Dysfunction (PIED) when using pornography in excess.

Men who have addicted to sex or porn may experience

Inability to obtain or maintain erections during intercourse or other sexual practise involving a partner

Premature ejaculation

Delayed ejaculation

Priapism (persistent painful erection of the penis)

Loss of sexual interest for the spouse/partner

Blaming the spouse/partner

PREMATURE EJACULATION

Premature or rapid ejaculation describes a condition where a man ejaculates (cums) too quickly. In its severe and rare form, the man cums before any direct stimulation to the penis occurs, including when he is just thinking about sexually stimulating situations.

It is more common for the man to ejaculate either during, or very soon after penetration. Studies suggest the average Intra Vaginal Ejaculatory Latency Time (IVELT), or the normal average time for the man to ejaculate, is 3-5 minutes after penetration. Obviously, some men regularly last much longer than this, just as there are men who regularly ejaculate much quicker.

The most important criteria of rapid ejaculation include

That ejaculation occurs sooner than the man and his partner wishes

And this is causing distress in their sexual relationship

Longer sex does not equal better sex

Premature ejaculation is not a lack of duration, but a lack of control

It is important to take the partner’s wishes into account, because what may seem rapid to the man may be already too long for the partner. Most men experience rapid ejaculation on occasions. There is nothing to be worried about.

It becomes a problem only when it occurs during most sexual interactions. Studies show that about 40% of men are troubled by this problem on more then an occasional basis. The effects of rapid ejaculation can be detrimental on relationships. Usually rapid ejaculation has psychological reasons. Physical origins are rare.

Treatment and Counselling

Affirmotive Sex Addiction Australia (ASAA) is a confidential sexual health counselling service. We provide Clinical Sex Therapy, Professional Counselling, and Sex Education for men and women, helping men to understand how their bodies work, and enable couples to reduce performance anxiety and developing sexual confidence and relationship harmony.

In some cases, where premature ejaculation persists, selective serotonin re-uptake inhibitor medication (anti-depressants) may be used.

A new SSRI medication, specifically developed for clinical treatments of premature ejaculation, called Priligy (Dapoxetine), is recommended. Ask your doctor for advise.

Some men with premature ejaculation report hypersensitivity to some parts of their penis. Those men may find relief with applying a topical anaesthetic to such sensitive penile areas, either delivered as a cream, spray or gel. Other men, who repeatedly experience unsatisfying erections or inability to maintain erections during their sexual act may benefit from obtaining a prescription of PDH5 inhibitor drugs, such as Viagra, Cialis or Levitra.

ERECTILE DYSFUNCTION AND IMPOTENCE

Impotence is the inability to achieve or maintain penile erections sufficient to complete satisfactory intercourse. In an estimated 10% of complete impotence, erections may not be achieved at all. Ejaculation and pleasure feelings are typically not affected.

Impotence can be classified as primary or secondary.

Primary Impotence: a man has never had successful intercourse with a partner but may achieve normal erections in other situations.

Secondary Impotence: despite current impotence problems, there is some history of success with completing intercourse in the past.

Many men will experience occasional or prolonged episodes of impotence usually resulting from severe stress, tiredness, lack of energy, relationship upheaval, anxiety, depression, medication for the treatment of depression, beta blockers, too much worrying about their sexual performance and resulting performance anxiety, or excessive drug (including prescription drugs) and alcohol abuse.

Physical causes of impotence may be created by cardiovascular problems, poor blood circulation, angina, longstanding or untreated high blood pressure, high cholesterol, obesity, diabetes, smoking, accident or injury to the spinal cord, and an array of life saving medications treating specific physical and mental health issues.

Impotence can also result from benign prostate enlargement or prostate cancer, with the enlarged prostate gland causing undue pressure on penile nerves. Life saving prostate surgery and treatments may also contribute to erectile dysfunction.

Impotence in Australian men is prevalent in about 3% in the 40-49 years old age group, 42% in the 60-69 years old age group, and increases to 64% in the 70-79 years old age group.

DELAYED EJACULATION

Delayed ejaculation, or DE, is a relatively rare condition and should not be confused with impotence. Delayed ejaculation is a condition of involuntary over-control of the ejaculatory reflex. There are multiple causes for DE and may include psychological and physical factors.

Understanding Male Orgasm and Ejaculation.

Male orgasm and ejaculation are two different phases and mostly (but not always) occur closely together. A man can orgasm without ejaculation, or ejaculate without orgasm.

Phase one – seminal fluid gathers inside the the base of the penis with usually no greater sensation then a ‘warning’ of the approaching orgasm.

Phase two – (shooting phase) requires the contraction of both, the striated and bulbar muscles of the perineum, and is responsible for orgasm. The perianal musculature is the area between the anus and the scrotum.

Phase two can be interrupted by a man’s conscious or unconscious thought process. This may include his lack of sexual focus and fantasy, a lack of privacy, a lack of sexual arousal, his fear of not being able to cum when he wants too, his expectations of sexual performance, and his negative beliefs of his ability to turning on and pleasing his partner. Such anxieties are reported to contributing to sexual dysfunction, including DE.

Desensitisation – Idiosyncratic Masturbation and habitual desensitisation of the penis (rubbing the penis against rough surfaces while masturbation, also intravenous self-injections) are possible causes in the development of delayed ejaculation.

Younger men who are starting out in sex and are ‘paralysed’ with sex negative feelings, such as anxiety, sexual inadequacy, sexual fears, sexual shame, or sexual guilt, are prone to be affected by DE.

Older men who have experienced an emotional stressful childhood or adulthood development, may have grown mistrustful of release and letting go, and may subsequently experience major difficulties with sexual release.

Men who have developed difficulties with being sensual may find it difficult to develop sexual thoughts and sufficient arousal.

Men who have developed aversions to their own, or to their partners, genitals may not achieve sufficient levels of arousal.

Men, who experience difficulties focusing on their own sexual pleasure, may be at risk to lose arousal/erections and developing delayed ejaculation.

Poor mental health and side-effects of prescription drugs including beta-blockers, some anti-depressants, and anti-psychotic medication can interfere with sexual arousal and ejaculation.

RETROGRADE EJACULATION

Retrograde ejaculation is a condition of ejaculating inwardly into the bladder. Retrograde ejaculation occurs when the internal sphincter or bladder neck does not close properly and the ejaculate is subsequently not forced out of the urethra but may flow back into the bladder. This condition is harmless and the ejaculate will be evacuated with the next urination.

Most men may not require any treatment.

For those men who opt for medical intervention, the following treatment options are available

Bladder neck reconstruction

Cryopreservation of semen, semen harvesting

Pharmacological treatment

Causation of Retrograde Ejaculation include

Certain medications

A history of diabetes Melitus

Damage to the bladder neck

Damage to the bladder neck’s nerve supply

Pelvic surgery and pelvic cancer surgery

Spinal cord lesions

TURP Trans-urethral resection of the prostate

Please see your GP or Urologist for appropriate advise. Men who want to start a family may also want to consult with a Fertility Specialist.

CONFIDENTIAL SEXUAL HEALTH COUNSELLING

Sex Therapist and Professional Counsellor Heide McConkey can help. You can contact our Sydney office during business hours (+61) 2 9380 4486 and book a confidential appointment, or obtain professional information on sex addiction and erectile dysfunction.